Neighbourhood Support Household Joining Form
Please fill in as much information as possible so we can support each other here in Laingholm & surrounding communities, & beyond. For help please email: (24/7) or phone toll-free 0800 007 008 (9am-9pm)
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Email *
First Name(s) *
Last Name(s) *
Other Email Address (otherwise leave blank)
Flat / Unit (eg. Unit A)
House number *
Street name *
Suburb *
Postcode *
Home phone number
Mobile phone number *
Mobile phone number 2
Work phone number(s)
Number of Household Occupants *
Would you like to subscribe to receive our fortnightly email with Police Intel Stats? *
Do you or any members of your household have any medical / physical needs, Optional - Please provide details (For emergency response contingency only)
Do you have a medical alarm ?
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Are you or someone in your household over 65? (For emergency response contingency only ) *
If you answered Yes, then please provide the name(s) of any people in your household who are over 65 (For emergency response contingency only)
A Street phone tree list works like this... one trusted person in your street has your number, in an emergency they will phone you, and you pass on the warning to two other people on your street. Do you give consent to be on your street phone tree list? *
Would you like us to send our Street Contact information about how to set up a NS group for your street? *
Thanks for completing the Neighbourhood Support Household Joining Form. Please click NEXT to gain access to valuable community resources
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